The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use

Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
Emerging Health Threats Journal 04/2011; 4(1):7107. DOI: 10.3402/ehtj.v4i0.7107
Source: PubMed


Ketamine was originally synthesised for use as a dissociative anaesthetic, and it remains widely used legitimately for this indication. However, there is increasing evidence of non-medical recreational use of ketamine, particularly in individuals who frequent the night-time economy. The population-level and sub-population (clubbers) prevalence of recreational use of ketamine is not known but is likely to be similar, or slightly lower than, that of other recreational drugs such as cocaine, MDMA, and amphetamine.
The predominant features of acute toxicity associated with the recreational use of ketamine are neuro-behavioural abnormalities such as agitation, hallucinations, anxiety, and psychosis. Secondary to these, individuals put themselves at greater risk of physical harm/trauma. Cardiovascular features (hypertension and tachycardia) occur less frequently and the risk of death from recreational use is low and is predominately due to the physical harm/trauma.
Long-term recreational use of ketamine can be associated with the development of psychological dependence and tolerance. There are reports of gastro-intestinal toxicity, particularly abdominal pain and abnormal liver function tests, and of neuropsychiatric disorders, typically a schizophrenia-like syndrome, in long-term users. Finally, there are increasing reports of urological disorders, particularly haemorrhagic cystitis, associated with long-term use. The management of these problems associated with the long-term use of ketamine is largely supportive and abstinence from ongoing exposure to ketamine.
In this review we will collate the available information on the epidemiology of recreational use of ketamine and describe the patterns of acute and chronic toxicity associated with its recreational use and the management of this toxicity.

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    • "Rapid tolerance to ketamine's characteristic acute psychoactive effects is well recognized and considered to be involved in the development of addictive behavior in recreational ketamine users (Jansen and Darracot-Cankovic 2001; Wolff and Winstock 2006; Kalsi, Wood, and Dargan 2011; Morgan and Curran 2012; Bokor and Anderson 2014). Trials of repeated or serial ketamine infusions did not describe any tolerance in ketamine's antidepressant response (Murrough et al. 2013; Rasmussen et al. 2013; Shiroma et al. 2014). "
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